Danielle van Dalen: There's more to consider before assisted dying

Researcher Danielle van Dalen says inequality of palliative care between regions and urban areas creates an unfair "inequality of choice" when it comes to legalising euthanasia. Photo / Getty Images

OPINION
Conversation around the End of Life Choice Act has often focused on a desire to be compassionate at the end of life, which is an excellent place to start.

But it is important to consider what compassion at the end of life looks like and the context and cost of the "compassionate response" of assisted suicide.

Over the last four years I've spoken to many medical professionals whose day-to-day job is caring for people at the end of life. Every one of them has said that when Hospice and palliative care is available and done well, the process of dying doesn't need to be painful or scary for people with terminal illness.

Unfortunately, while our palliative care in cities and large towns is world class, the availability of this care elsewhere in New Zealand is patchy. The overwhelming majority of doctors and nurses who spend every day offering palliative care to people who are dying are convinced a more effective approach would be to improve access to this kind of care for all New Zealanders before we offer assisted suicide.

In fact, in 2015 when Scotland considered assisted dying legislation, they also heard this perspective. They found that "there are ways of responding to suffering (such as increased focus on palliative care and supporting those with disabilities) which do not raise the kind of concerns about crossing a legal and ethical 'Rubicon' that are raised by assisted suicide". They rejected assisted dying, and focused on improving their palliative care services instead.

The End of Life Choice Act takes the opposite approach – providing the choice of assisted dying for those people who want it, while suggesting that those who don't want it can simply say no.

In reality, however, people make choices that are shaped by the available options. The act poses a new, previously unthinkable question to every person who fits the criteria; "Should I?".

It provides the option of lawful assisted death for people who are comfortable, well-supported, autonomous and resolute in their decision, but it offers the same option to vulnerable New Zealanders who fit the criteria and may be far away from good Hospice care, depressed, or have difficult family or financial situations.

While the act states that a person cannot use mental illness as reason to qualify for assisted dying, it doesn't exclude people who have a terminal illness with six months to live and are also suffering from a mental disorder or illness. In so doing, it ignores research that when first diagnosed with a terminal illness most people will struggle with depression (which can be very difficult for doctors to detect). And yet, research also shows that with time and medication this depression and wish to hasten death is treatable and the person can find their joy for life again.

Providing a form of compassion at the end of life might be a goal for the End of Life Choice Act, but this new choice creates an inequality of options for New Zealanders who are vulnerable and lack equal access to good palliative care.

• Danielle van Dalen is a researcher at the Maxim Institute.